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Shirozhan S, Rafiee-Vardanjani L, Motie M, Mohamadi S. Home-based telerehabilitation in multiple sclerosis: a scoping review. BMJ Support Palliat Care 2024:spcare-2024-004821. [PMID: 39084690 DOI: 10.1136/spcare-2024-004821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Introducing home-based telerehabilitation (TR) approaches helps clinical experts to choose appropriate and effective interventions and researchers identify knowledge gaps to design clinical trial studies and systematic reviews. PURPOSE This study aimed to review the knowledge of home-based TR in multiple sclerosis. METHOD This scoping review study was conducted based on Arksey and O'Malley's five-step approach. The Embase, PubMed, Cochrane, Web of Sciences, Scopus and ProQuest databases were searched in 2017-2024 to find full-text English-language articles. FINDINGS In 25 studies reviewed, various and extensive home-based interventions have been used in physical and cognitive aspects. CONCLUSION Home-based rehabilitation is applicable, useful, safe and affordable, maintains the continuity of the rehabilitation process and increases patients' adherence to the rehabilitation programme. However, there are challenges such as patients' lack of familiarity with technology and limitations of outcome measurement tools that should be addressed in future studies.
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Affiliation(s)
- Shima Shirozhan
- Department of Nursing, Health in Emergency and Disaster Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Leila Rafiee-Vardanjani
- Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mahdieh Motie
- Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shamaneh Mohamadi
- Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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2
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Liu CJ, Burch H, Glover S, Donofrio A, Oliveros G, DeMeo G. Practice Patterns and Responses to the Patient-Driven Groupings Model and Coronavirus Disease 2019 Pandemic in Home Health Occupational Therapy: A Pilot Survey Study. Occup Ther Health Care 2024; 38:567-581. [PMID: 37021967 DOI: 10.1080/07380577.2023.2196691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/02/2022] [Indexed: 04/07/2023]
Abstract
The purpose of the pilot survey was to understand current practice patterns and responses to the Patient-Driven Groupings Model and the coronavirus disease 2019 (COVID-19) pandemic in home health occupational therapy care. Fifty home health occupational therapy practitioners from 27 states in the United States completed the survey. Descriptive analysis was used to organize and summarize survey responses. The survey items on practice patterns included assessment tools, treatment approaches, and care coordination with physical therapy colleagues. The most reported assessment of occupational performance was the Barthel Index. The common treatment approaches included activities of daily living retraining, energy conservation, and functional mobility and transfer. The majority of respondents (n = 44) communicated with their physical therapy colleagues at least once a week. The communications were often related to scheduling and changes in a patient's condition. Seventy percent of practitioners experienced a reduction in home visits during the recent Medicare payment reform and the pandemic. These practitioners perceived that some patients might have been discharged from home health care prematurely. Additional studies to investigate the impact of policy changes and the pandemic on therapy intensity and patients' functional outcomes are warranted.
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Affiliation(s)
- Chiung-Ju Liu
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Hannah Burch
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Sabrina Glover
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Abigail Donofrio
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Gianna Oliveros
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Gianna DeMeo
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
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Saari ME, Giosa JL, Holyoke P, Heckman GA, Hirdes JP. Profiling the medical, functional, cognitive, and psychosocial care needs of adults assessed for home care in Ontario, Canada: The case for long-term 'life care' at home. PLoS One 2024; 19:e0300521. [PMID: 38558082 PMCID: PMC10984553 DOI: 10.1371/journal.pone.0300521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Calls to leverage routinely collected data to inform health system improvements have been made. Misalignment between home care services and client needs can result in poor client, caregiver, and system outcomes. To inform development of an integrated model of community-based home care, grounded in a holistic definition of health, comprehensive clinical profiles were created using Ontario, Canada home care assessment data. Retrospective, cross-sectional analyses of 2017-2018 Resident Assessment Instrument Home Care (RAI-HC) assessments (n = 162,523) were completed to group home care clients by service needs and generate comprehensive profiles of each group's dominant medical, functional, cognitive, and psychosocial care needs. Six unique groups were identified, with care profiles representing home care clients living with Geriatric Syndromes, Medical Complexity, Cognitive Impairment and Behaviours, Caregiver Distress and Social Frailty. Depending on group membership, between 51% and 81% of clients had identified care needs spanning four or more Positive Health dimensions, demonstrating both the heterogeneity and complexity of clients served by home care. Comprehensive clinical profiles, developed from routinely collected assessment data, support a future-focused, evidence-informed, and community-engaged approach to research and practice in integrated home-based health and social care.
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Affiliation(s)
- Margaret E. Saari
- SE Research Centre, SE Health, Markham, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Justine L. Giosa
- SE Research Centre, SE Health, Markham, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - George A. Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - John P. Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Kruizinga J, Fisher K, Guthrie D, Northwood M, Kaasalainen S. Comparing quality indicator rates for home care clients receiving palliative and end-of-life care before and during the Covid-19 pandemic. BMC Palliat Care 2024; 23:11. [PMID: 38178110 PMCID: PMC10768311 DOI: 10.1186/s12904-023-01336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The consensus among Canadians with regards to end-of-life preferences is that with adequate support the majority prefer to live and die at home. PURPOSE To compare quality indicator (QI) rates for home care clients receiving palliative and end-of-life care prior to and after the onset of the COVID-19 pandemic. METHODS A retrospective population-based cohort design was used. Sixteen QIs informed by existing literature and a preliminary set of QIs recently evaluated by a modified Delphi panel were compared. Data were obtained from the interRAI Palliative Care instrument for Ontario home care clients for two separate cohorts: the pre-COVID (January 14, 2019 to March 16, 2020) and COVID cohort (March 17, 2020 to May 18, 2021). A propensity score analysis was used to match (using nearest neighbour matching) on 21 covariates, resulting in a sample size of 2479 unique interRAI Palliative Care assessments in each cohort. Alternative propensity score methods were explored as part of a sensitivity analysis. RESULTS After matching the pre-COVID and COVID cohorts, five of the 16 QIs had statistically significant differences in the QI rates (change from pre-COVID to COVID): decrease in prevalence of severe or excruciating daily pain (p = 0.03, effect size=-0.08), decrease in prevalence of caregiver distress (p = 0.02, effect size=-0.06), decrease in prevalence of negative mood (p = 0.003, effect size=- 0.17), decrease in prevalence of a delirium-like syndrome (p = 0.001, effect size=-0.25) and decrease in prevalence of nausea or vomiting (p = 0.04, effect size=-0.06). While the alternative propensity score methods produced slightly different results, no clinically meaningful differences were seen between the cohorts when effect sizes were examined. All methods were in agreement regarding the highest QI rates, which included the prevalence of shortness of breath with activity, no advance directives, and fatigue. CONCLUSION This study is the first to examine differences in QI rates for home care clients receiving palliative and end-of-life care before and during COVID in Ontario. It appears that QI rates did not change over the course of the pandemic in this population. Future work should be directed to understanding the temporal variation in these QI rates, risk-adjusting the QI rates for further comparison among jurisdictions, provinces, and countries, and in creating benchmarks for determining acceptable rates of different QIs.
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Affiliation(s)
- Julia Kruizinga
- McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
| | - Kathryn Fisher
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
| | - Dawn Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, ON, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Melissa Northwood
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
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Roy I, Karmarkar AM, Lininger MR, Jain T, Martin BI, Kumar A. Association Between Hospital Participation in Value-Based Programs and Timely Initiation of Post-Acute Home Health Care, Functional Recovery, and Hospital Readmission After Joint Replacement. Phys Ther 2023; 103:pzad123. [PMID: 37694820 PMCID: PMC10715680 DOI: 10.1093/ptj/pzad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/08/2023] [Accepted: 07/05/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES This study examined the association between hospital participation in Bundled Payments for Care Improvement (BPCI) or Comprehensive Care for Joint Replacement (CJR) and the timely initiation of home health rehabilitation services for lower extremity joint replacements. Furthermore, this study examined the association between the timely initiation of home health rehabilitation services with improvement in self-care, mobility, and 90-day hospital readmission. METHOD This retrospective cohort study used Medicare inpatient claims and home health assessment data from 2016 to 2017 for older adults discharged to home with home health following hospitalization after joint replacement. Multilevel multivariate logistic regression was used to examine the association between hospital participation in BPCI or CJR programs and timely initiation of home health rehabilitation service. A 2-staged generalized boosted model was used to examine the association between delay in home health initiation and improvement in self-care, mobility, and 90-day risk-adjusted hospital readmission. RESULTS Compared with patients discharged from hospitals that did not have BPCI or CJR, patients discharged from hospitals with these programs had a lower likelihood of delayed initiation of home health rehabilitation services for both knees and hip replacement. Using propensity scores as the inverse probability of treatment weights, delay in the initiation of home health rehabilitation services was associated with lower improvement in self-care (odds ratio [OR] = 1.23; 95% CI = 1.20-1.26), mobility (OR = 1.15; 95% CI = 1.13-1.18), and higher rate of 90-day hospital readmission (OR = 1.19; 95% CI = 1.15-1.24) for knee replacement. Likewise, delayed initiation of home health rehabilitation services was associated with lower improvement in self-care (OR = 1.16; 95% CI = 1.13-1.20) and mobility (OR = 1.26; 95% CI = 1.22-1.30) for hip replacement. CONCLUSION Hospital participation in BPCI or comprehensive CJR was associated with early home health rehabilitation care initiation, which was further associated with significant increases in functional recovery and lower risks of hospital readmission. IMPACT Policy makers may consider incentivizing health care providers to initiate early home health services and care coordination in value-based payment models.
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Affiliation(s)
- Indrakshi Roy
- Department of Health Sciences, Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Amol M Karmarkar
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Sheltering Arms Institute, Richmond, Virginia, USA
| | - Monica R Lininger
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, Arizona, USA
| | - Tarang Jain
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, Arizona, USA
| | - Brook I Martin
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, USA
| | - Amit Kumar
- Department of Physical Therapy and Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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Mofina A, Miller J, Tranmer J, Li W, Donnelly C. The association between receipt of home care rehabilitation services and acute care hospital utilization in clients with multimorbidity following an acute care unit discharge: a retrospective cohort study. BMC Health Serv Res 2023; 23:269. [PMID: 36934243 PMCID: PMC10024414 DOI: 10.1186/s12913-023-09116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/27/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Individuals experiencing multimorbidity have more complex healthcare needs, use more healthcare services, and access multiple service providers across the healthcare continuum. They also experience higher rates of functional decline. Rehabilitation therapists are well positioned to address these functional needs; however, little is known about the influence of rehabilitation therapy on patient outcomes, and subsequent unplanned healthcare utilization for people with multimorbidity. The aims of this study were to: 1) describe and compare the characteristics of people with multimorbidity receiving: home care rehabilitation therapy alone, other home care services without rehabilitation therapy, and the combination of home care rehabilitation therapy and other home care services, and 2) determine the association between home care rehabilitation therapy and subsequent healthcare utilization among those recently discharged from an acute care unit. METHODS This retrospective cohort study used linked health administrative data housed within ICES, Ontario, Canada. The cohort included long-stay home care clients experiencing multimorbidity who were discharged from acute care settings between 2007-2015 (N = 43,145). Descriptive statistics, ANOVA's, t-tests, and chi-square analyses were used to describe and compare cohort characteristics. Multivariable logistic regression was used to understand the association between receipt of rehabilitation therapy and healthcare utilization. RESULTS Of those with multimorbidity receiving long-stay home care services, 45.5% had five or more chronic conditions and 46.3% required some assistance with ADLs. Compared to people receiving other home care services, those receiving home care rehabilitation therapy only were less likely to be readmitted to the hospital (OR = 0.78; 95% CI: 0.73-0.83) and use emergency department services (OR = 0.73; 95% CI: 0.69-0.78) within the first 3-months following hospital discharge. CONCLUSIONS Receipt of rehabilitation therapy was associated with less unplanned healthcare service use when transitioning from hospital to home among persons with multimorbidity. These findings suggest rehabilitation therapy may help to reduce the healthcare burden for individuals and health systems. Future research should evaluate the potential cost savings and health outcomes associated with providing rehabilitation therapy services for people with multimorbidity.
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Affiliation(s)
- Amanda Mofina
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, Kingston, ON, Canada
- ICES, Queen's, Kingston, ON, Canada
| | | | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Northwood M, Turcotte LA, McArthur C, Egbujie BA, Berg K, Boscart VM, Heckman GA, Hirdes JP, Wagg AS. Changes in Urinary Continence After Admission to a Complex Care Setting: A Multistate Transition Model. J Am Med Dir Assoc 2022; 23:1683-1690.e2. [PMID: 35870485 DOI: 10.1016/j.jamda.2022.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To examine changes in urinary continence for post-acute, Complex Continuing Care hospital patients from time of admission to short-term follow-up, either in hospital or after discharge to long-term care or home with services. DESIGN Retrospective cohort study of patients in Complex Continuing Care hospitals using clinical data collected with interRAI Minimum Data Set 2.0 and interRAI Resident Assessment Instrument Home Care. SETTING AND PARTICIPANTS Adults aged 18 years and older, admitted to Complex Continuing Care hospitals in Ontario, Canada, between 2009 and 2015 (n = 78,913). METHODS A multistate transition model was used to characterize the association between patient characteristics measured at admission and changes in urinary continence state transitions (continent, sometimes continent, and incontinent) between admission and follow-up. RESULTS The cohort included 27,896 patients. At admission, 9583 (34.3%) patients belonged to the continent state, 6441 (23.09%) patients belonged to the sometimes incontinent state, and the remaining 11,872 (42.6%) patients belonged to the incontinent state. For patients who were continent at admission, the majority (62.7%) remained continent at follow-up. However, nearly a quarter (23.9%) transitioned to the sometimes continent state, and an additional 13.4% became incontinent at follow-up. Several factors were associated with continence state transitions, including cognitive impairment, rehabilitation potential, stroke, Parkinson's disease, Alzheimer's disease and related dementias, and hip fracture. CONCLUSIONS AND IMPLICATIONS This study suggests that urinary incontinence is a prevalent problem for Complex Continuing Care hospital patients and multiple factors are associated with continence state transitions. Standardized assessment of urinary incontinence is helpful in this setting to identify patients in need of further assessment and patient-centered intervention and as a quality improvement metric to examine changes in continence from admission to discharge.
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Affiliation(s)
| | - Luke A Turcotte
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Katherine Berg
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Schlegel Research Chair in Geriatric Medicine, Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Adrian S Wagg
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
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Htun HL, Wong LH, Lian W, Koh J, Lee LT, Lim JP, Leong I, Lim WY. Functional improvement after inpatient rehabilitation in community hospitals following acute hospital care. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:357-369. [PMID: 35786756 DOI: 10.47102/annals-acadmedsg.2021507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION There are limited studies exploring functional improvement in relation to characteristics of patients who, following acute hospital care, receive inpatient rehabilitation in community hospitals. We evaluated the association of acute hospital admission-related factors with functional improvement on community hospital discharge. METHODS We conducted a retrospective cohort study among patients who were transferred to community hospitals within 14-day post-discharge from acute hospital between 2016 and 2018. Modified Barthel Index (MBI) on a 100-point ordinal scale was used to assess functional status on admission to and discharge from the community hospital. We categorised MBI into 6 bands: 0-24, 25-49, 50-74, 75-90, 91-99 and 100. Multivariable logistic regression models were constructed to determine factors associated with categorical improvement in functional status, defined as an increase in at least one MBI band between admission and discharge. RESULTS A total of 5,641 patients (median age 77 years, interquartile range 69-84; 44.2% men) were included for analysis. After adjusting for potential confounders, factors associated with functional improvement were younger age, a higher MBI on admission, and musculoskeletal diagnosis for the acute hospital admission episode. In contrast, a history of dementia or stroke; lower estimated glomerular filtration rate; abnormal serum albumin or anaemia measured during the acute hospital episode; and diagnoses of stroke, cardiac disease, malignancy, falls or pneumonia; and other chronic respiratory diseases were associated with lower odds of functional improvement. CONCLUSION Clinicians may want to take into account the presence of these high-risk factors in their patients when planning rehabilitation programmes, in order to maximise the likelihood of functional improvement.
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Affiliation(s)
- Htet Lin Htun
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
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Khamnon N, Amatachaya S, Wattanapan P, Musika N, Jitmongkolsri P, Kongngoen N, Haisirikul M, Jaikarsen K, Thaweewannakij T, Namwong W. Reliability and concurrent validity of the Spinal Cord Independence Measure III among rehabilitation professionals. Spinal Cord 2022; 60:875-881. [PMID: 35477744 PMCID: PMC9043886 DOI: 10.1038/s41393-022-00807-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 11/19/2022]
Abstract
Study design A cross-sectional design. Objectives To investigate rater reliability of the Spinal Cord Independence Measure or SCIM III among rehabilitation professionals, along with the concurrent validity of the tool as compared to standard measures covering wheelchair users (WU) and ambulatory (AM) individuals with spinal cord injury (SCI). Setting A tertiary rehabilitation center and communities. Methods Eighty-two participants with SCI (39 WU and 43 AM individuals) were assessed using SCIM III items. The data of first 30 participants were video recorded for rater reliability assessments by seven rehabilitation professionals, including nurses, occupational therapists, and physical therapists (one novice and one experienced rater for each professional). All participants were also assessed using standard measures to verify concurrent validity of SCIM III by an experienced rater. Results The SCIM III showed excellent intra-rater and inter-rater reliability among rehabilitation professionals when analyzed for overall items (intraclass correlation coefficient (ICC) >0.90) and separately for each subscale (kappa values >0.80). The total SCIM III of WU and the mobility scores of AM participants showed significant correlation with standard measures for muscle strength, limit of stability, balance control, functional endurance, and walking ability (rs = 0.343–0.779; p < 0.05). Conclusions The present findings extend clinical benefit and confirm the use of SCIM III interchangeably among rehabilitation professionals after they have been adequately trained. The findings are important for community-based rehabilitation and home healthcare services, especially during the coronavirus (COVID-19) pandemic, when hospital beds and in-patient services are limited for individuals with SCI.
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Affiliation(s)
- Narongsak Khamnon
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Sugalya Amatachaya
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand. .,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand.
| | - Pattra Wattanapan
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand.,Department of Rehabilitation, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nisara Musika
- Department of Rehabilitation, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Napaporn Kongngoen
- Maehongson Special Education Center, Bureau of Special Education Administration, Ministry of Education, Maehongson, Thailand
| | - Manatsavee Haisirikul
- Physical Therapy, Department of Rehabilitation, Buri Ram Hospital, Buri Ram, Thailand
| | - Kittiyaporn Jaikarsen
- Occupational Therapy, Department of Rehabilitation, Buri Ram Hospital, Buri Ram, Thailand
| | - Thiwabhorn Thaweewannakij
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Wilairat Namwong
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
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Adekpedjou R, Heckman GA, Hébert PC, Costa AP, Hirdes J. Outcomes of advance care directives after admission to a long-term care home: DNR the DNH? BMC Geriatr 2022; 22:22. [PMID: 34979935 PMCID: PMC8725447 DOI: 10.1186/s12877-021-02699-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Residents of long-term care homes (LTCH) often experience unnecessary and non-beneficial hospitalizations and interventions near the end-of-life. Advance care directives aim to ensure that end-of-life care respects resident needs and wishes. METHODS In this retrospective cohort study, we used multistate models to examine the health trajectories associated with Do-Not-Resuscitate (DNR) and Do-Not-Hospitalize (DNH) directives of residents admitted to LTCH in Ontario, Alberta, and British Columbia, Canada. We adjusted for baseline frailty-related health instability. We considered three possible end states: change in health, hospitalization, or death. For measurements, we used standardized RAI-MDS 2.0 LTCH assessments linked to hospital records from 2010 to 2015. RESULTS We report on 123,003 LTCH residents. The prevalence of DNR and DNH directives was 71 and 26% respectively. Both directives were associated with increased odds of transitioning to a state of greater health instability and death, and decreased odds of hospitalization. The odds of hospitalization in the presence of a DNH directive were lowered, but not eliminated, with odds of 0.67 (95% confidence interval 0.65-0.69), 0.63 (0.61-0.65), and 0.47 (0.43-0.52) for residents with low, moderate and high health instability, respectively. CONCLUSION Even though both DNR and DNH orders are associated with serious health outcomes, DNH directives were not frequently used and often overturned. We suggest that policies recommending DNH directives be re-evaluated, with greater emphasis on advance care planning that better reflects resident values and wishes.
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Affiliation(s)
- Rhéda Adekpedjou
- Carrefour de l'innovation et de l'évaluation en santé, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
- Schlegel Research Institute for Aging, Waterloo, Canada.
| | - Paul C Hébert
- Carrefour de l'innovation et de l'évaluation en santé, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | | | - John Hirdes
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
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The effects of early post-discharge rehabilitation services on care-needs level deterioration in older adults with functional impairment: A propensity score–matched study. Arch Phys Med Rehabil 2022; 103:1715-1722.e1. [DOI: 10.1016/j.apmr.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022]
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12
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Seow H, Dutta P, Johnson MJ, McMillan K, Guthrie DM, Costa AP, Currow DC. Prevalence and Risk Factors of Breathlessness Across Canada: A National Retrospective Cohort Study in Home Care and Nursing Home Populations. J Pain Symptom Manage 2021; 62:346-354.e1. [PMID: 33276042 DOI: 10.1016/j.jpainsymman.2020.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/21/2022]
Abstract
CONTEXT Breathlessness is a symptom associated with poor clinical outcomes and prognosis. Little is known about its long-term trends and associations with social factors including decline in social activities and caregiver distress. OBJECTIVES To describe factors associated with the prevalence of clinician-reported breathlessness across Canada among cohorts receiving home care or nursing home care. METHODS A retrospective observational cohort study of cross-sectional intake assessment data from Canadian interRAI Home Care and Nursing Home data sets. In each data set, we examined covariates associated with the presence of clinician-reported breathlessness using multivariate regression. RESULTS Between 2007 and 2018, we identified 1,317,117 and 469,709 individuals from the home care and nursing home data sets, respectively. Over two-thirds were aged >75 and over 60% were women. Breathlessness was present at intake in 26.0% of the home care and 8.2% of the nursing home cohorts. Between 2007 and 2018, prevalence of breathlessness increased by 10% for the home care cohort, while remaining relatively constant in nursing homes. Covariates associated with increased odds of having clinician-reported breathlessness at intake in both cohorts were moderate-severe impairment with activities of daily living, being male, older age, high pain scores, signs of depression, and decline in social activities. In the home care cohort, the presence of breathlessness was associated with a greater odds of caregiver distress (odds ratio = 1.19, 95% CI: 1.18-1.20). CONCLUSION The prevalence of clinician-reported breathlessness is higher in home care than in nursing home populations, the former having risen by 10% over the decade. Prevalence of breathlessness is associated with decline in social activities and caregiver distress. Enhanced supports may be required to meet increasing patient need in the community.
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Affiliation(s)
- Hsien Seow
- McMaster University, Hamilton, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | | | | | | | | | - Andrew P Costa
- McMaster University, Hamilton, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Chiu TY, Yu HW, Chen YM. Continuous Use of Home Care Services and Functional Performance: A Population-Based Approach. J Appl Gerontol 2021; 41:736-743. [PMID: 34291697 DOI: 10.1177/07334648211032419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Home care (HC) services are the foundational service in Taiwan, such as personal care, housekeeping, showers, meal preparation, and so on. We used population-representative data to evaluate the effects of HC services use on the long-term functional performance of older adults. METHOD This longitudinal study used latent growth curve modeling, measured as trajectories in activities of daily living (ADL) ability. We retrieved data for 1,851 care recipients from the Long-Term Care Service Management System database. RESULTS Continuous use of HC services had positive effects on functional performance over time of declining functional capacity (β = .075, p < .05). While greater age was associated with slower increases in ADL scores, being female and living alone were associated with faster increases in ADL scores. DISCUSSION Continuous use of the HC services provided has a significant impact on maintaining or improving functional performance among older adults in the early stage of declined functional capacity.
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Affiliation(s)
- Tzu-Ying Chiu
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei City, Taiwan
| | - Hsiao-Wei Yu
- Department of Gerontological Care and Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Family Medicine, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan.,Geriatric and Long-term Care Research Center. Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
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14
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Heckman GA, Hirdes JP, Hébert P, Costa A, Onder G, Declercq A, Nova A, Chen J, McKelvie RS. Assessments of heart failure and frailty-related health instability provide complementary and useful information for home care planning and prognosis. Can J Cardiol 2021; 37:1767-1774. [PMID: 34303783 DOI: 10.1016/j.cjca.2021.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Health instability, measured with the Changes in Health and End-stage disease Signs and Symptoms (CHESS) scale, predicts hospitalizations and mortality in home care clients. Heart failure (HF) is also common among home care clients. We seek to understand how HF contributes to the odds of death, hospitalization or worsening health among new home care clients depending on admission health instability. METHODS We undertook a retrospective cohort study of home care clients aged 65 years and older between January 1st 2010 and March 31st 2015 from Alberta, British Columbia, Ontario, and the Yukon, Canada. We used multistate Markov models to derive adjusted odds ratios (OR) for transitions to different health instability states, hospitalization, and death. We examined the role of HF and CHESS at 6 months after home care admission. RESULTS The sample included 286,232 clients. Those with HF had greater odds of worsening health instability than those without HF. At low-moderate admission health instability (CHESS 0-2), clients with HF had greater odds of hospitalization and death than those without HF. Clients with HF and high health instability (CHESS≥3) had slightly greater odds of hospitalization (OR 1.08, 95% Confidence Interval 1.02-1.13) but similar odds of death (OR 1.024, 95% CI 0.937-1.120) compared to clients without HF. CONCLUSIONS Among new home care clients, a HF diagnosis predicts death, hospitalization and worsening health, predominantly among those with low-moderate admission health instability. A HF diagnosis and admission CHESS score provide complementary information to support care planning in this population.
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Affiliation(s)
- George A Heckman
- Schlegel Research Institute for Aging, Waterloo, Ontario, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Paul Hébert
- Carrefour de l'innovation et de l'évaluation en santé, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Andrew Costa
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Anja Declercq
- LUCAS - Center for Care Research and Consultancy & CESO - Center for Sociological Research, KU Leuven, Belgium
| | - Amanda Nova
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada; LUCAS - Center for Care Research and Consultancy & CESO - Center for Sociological Research, KU Leuven, Belgium
| | - Jonathan Chen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Robert S McKelvie
- Division of Cardiology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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15
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Johansson A, Ernsth Bravell M, Fransson EI, Fristedt S. Factors associated to functioning and health in relation to home rehabilitation in Sweden: a non-randomized pre-post intervention study. BMC Geriatr 2021; 21:416. [PMID: 34229616 PMCID: PMC8258925 DOI: 10.1186/s12877-021-02360-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background Home rehabilitation is a growing rehabilitation service in many countries, but scientific knowledge of its components and outcomes is still limited. The aim of this study was to investigate; 1) which changes in functioning and self-rated health could be identified in relation to a home rehabilitation program in a population of community-dwelling citizens, and 2) how socio-demographic factors, health conditions and home rehabilitation interventions were associated to change in functioning and self-rated health after the home rehabilitation program. Method The sample consisted of participants in a municipal home rehabilitation project in Sweden and consisted of 165 community-dwelling citizens. General Linear Models (ANOVA repeated measures) was used for identifying changes in rehabilitation outcomes. Logistic regressions analysis was used to investigate associations between rehabilitation outcomes and potential factors associated to outcome. Result Overall improvements in functioning and self-rated health were found after the home rehabilitation program. Higher frequencies of training sessions with occupational therapists, length of home rehabilitation, and orthopaedic conditions of upper extremities and spine as the main health condition, were associated with rehabilitation outcomes. Conclusion The result indicates that the duration of home rehabilitation interventions and intensity of occupational therapy, as well as the main medical condition may have an impact on the outcomes of home rehabilitation and needs to be considered when planning such programs. However, more research is needed to guide practice and policymaking.
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Affiliation(s)
- Anette Johansson
- Health Care Administration, Jönköping Municipality, Jönköping, Sweden. .,School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | | | | | - Sofi Fristedt
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Ropke A, Lund K, Thrane C, Juhl C, Morville AL. Developing an individualised cross-sectoral programme based on activities of daily living to support rehabilitation of older adults with hip fracture: a qualitative study. BMJ Open 2021; 11:e044539. [PMID: 34145009 PMCID: PMC8215248 DOI: 10.1136/bmjopen-2020-044539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To develop an individualised rehabilitation programme for personal and instrumental activities of daily living (ADL) tasks, enabling older adults with hip fractures to perform ADL safely and independently. DESIGN Qualitative study inspired by the complex intervention development (Medical Research Council framework phase I) using literature search and research circles. SETTINGS University Hospital of Copenhagen, Herlev and Gentofte, and Herlev and Gentofte municipalities. PARTICIPANTS One research circle with seven older adults with hip fractures, and one with seven healthcare professionals (occupational therapists and physiotherapists). RESULTS Three generic categories were identified: (1) 'Challenge older adults with goal-oriented ADL tasks', (2) 'Implement strategies to enhance independent and safe performance of ADL tasks', and (3) 'Communicate the important information to the target group and across sectors'. A programme was developed and an intervention to enhance usual rehabilitation was designed comprising: an individualised intervention component consisting of five additional therapy sessions; one during hospitalisation, four in the municipality and a follow-up phone call. CONCLUSIONS Engaging and integrating activities into rehabilitation treatment may support rehabilitation. Our study highlighted the need for setting individual goals and challenging older adults with hip fracture by providing guidance in strategies to enhance safe and independent performance of ADL tasks. Furthermore, the need for providing older adults with hip fracture and healthcare professionals with written and oral information about goal setting during the transitional rehabilitation phase was emphasised. Including the perspectives of older adults with hip fracture and healthcare professionals added value to the rehabilitation, and thus ensured an adequate, tangible and implementable rehabilitation programme. TRIAL REGISTRATION NUMBER This article is the first of three articles inspired by Medicial Research Council guidelines. The next study is a feasibility study with the trial registration: ClinicalTrials.gov ID: NCT03828240. The results are right now being written in article. The third study is a randomised controlled trial with the trial registration: ClinicalTrials.gov ID: NCT04207788; Pre-results.
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Affiliation(s)
- Alice Ropke
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karina Lund
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Camilla Thrane
- Health Promotion and Rehabilitation, Municipality of Herlev, Herlev, Denmark
| | - Carsten Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anne-Le Morville
- ADULT Research Group, Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Conen K, Guthrie DM, Stevens T, Winemaker S, Seow H. Symptom trajectories of non-cancer patients in the last six months of life: Identifying needs in a population-based home care cohort. PLoS One 2021; 16:e0252814. [PMID: 34129643 PMCID: PMC8205160 DOI: 10.1371/journal.pone.0252814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/23/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The end-of-life symptom prevalence of non-cancer patients have been described mostly in hospital and institutional settings. This study aims to describe the average symptom trajectories among non-cancer patients who are community-dwelling and used home care services at the end of life. MATERIALS AND METHODS This is a retrospective, population-based cohort study of non-cancer patients who used home care services in the last 6 months of life in Ontario, Canada, between 2007 and 2014. We linked the Resident Assessment Instrument for Home Care (RAI-HC) (standardized home care assessment tool) and the Discharge Abstract Databases (for hospital deaths). Patients were grouped into four non-cancer disease groups: cardiovascular, neurological, respiratory, and renal (not mutually exclusive). Our outcomes were the average prevalence of these outcomes, each week, across the last 6 months of life: uncontrolled moderate-severe pain as per the Pain Scale, presence of shortness of breath, mild-severe cognitive impairment as per the Cognitive Performance Scale, and presence of caregiver distress. We conducted a multivariate logistic regression to identify factors associated with having each outcome respectively, in the last 6 months. RESULTS A total of 20,773 non-cancer patient were included in our study, which were analyzed by disease groups: cardiovascular (n = 12,923); neurological (n = 6,935); respiratory (n = 6,357); and renal (n = 3,062). Roughly 80% of patients were > 75 years and half were female. In the last 6 months of life, moderate to severe pain was frequent in the cardiovascular (57.2%), neurological (42.7%), renal (61.0%) and respiratory (58.3%) patients. Patients with renal disease had significantly higher odds for reporting uncontrolled moderate to severe pain (odds ratio [OR] = 1.21; 95% CI: 1.08 to 1.34) than those who did not. Patients with respiratory disease reported significantly higher odds for shortness of breath (5.37; 95% CI, 5.00 to 5.80) versus those who did not. Patients with neurological disease compared to those without were 9.65 times more likely to experience impaired cognitive performance and had 56% higher odds of caregiver distress (OR = 1.56; 95% CI: 1.43 to 1.71). DISCUSSION In our cohort of non-cancer patients dying in the community, pain, shortness of breath, impaired cognitive function and caregiver distress are important symptoms to manage near the end of life even in non-institutional settings.
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Affiliation(s)
- Katrin Conen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, Division of Palliative Care, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Dawn M. Guthrie
- Department of Kinesiology & Physical Education Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Tara Stevens
- Department of Kinesiology & Physical Education Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Samantha Winemaker
- Department of Family Medicine, Division of Palliative Care, McMaster University, Hamilton, Ontario, Canada
| | - Hsien Seow
- Department of Family Medicine, Division of Palliative Care, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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18
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Seow H, Guthrie DM, Stevens T, Barbera LC, Burge F, McGrail K, Chan KKW, Peacock SJ, Sutradhar R. Trajectory of End-of-Life Pain and Other Physical Symptoms among Cancer Patients Receiving Home Care. ACTA ACUST UNITED AC 2021; 28:1641-1651. [PMID: 33924801 PMCID: PMC8161760 DOI: 10.3390/curroncol28030153] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the trajectory of physical symptoms among cancer decedents who were receiving home care in the six months before death. PATIENTS AND METHODS An observational cohort study of cancer decedents in Ontario, Canada, who received home care services between 2007 and 2014. To be included, decedents had to use at least one home care service in the last six months of life. Outcomes were the presence of pain and several other physical symptoms at each week before death. RESULTS Our cohort included 27,295 cancer decedents (30,368 assessments). Forty-seven percent were female and 56% were age 75 years or older. The prevalence of all physical symptoms increased as one approached death, particularly in the last month of life. In the last weeks of life, 69% of patients reported having moderate-severe pain; however, only 20% reported that the pain was not controlled. Loss of appetite (63%), shortness of breath (59%), high health instability (50%), and self-reported poor health (44%) were also highly prevalent in the last week of life. Multivariate regression showed that caregiver distress, high health instability, social decline, uncontrolled pain, and signs of depression all worsened the odds of having a physical symptom in the last 3 months of life. CONCLUSION In this large home care cancer cohort, trajectories of physical symptoms worsened close to death. While presence of moderate-severe pain was common, it was also reported as mostly controlled. Covariates, such as caregiver distress and social decline, were associated with having more physical symptoms at end of life.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada;
- Correspondence: ; Tel.: +1-905-387-9711 (ext. 67175); Fax: +1-905-575-6308
| | - Dawn M. Guthrie
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada; (D.M.G.); (T.S.)
| | - Tara Stevens
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada; (D.M.G.); (T.S.)
| | - Lisa C. Barbera
- Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Kelvin K. W. Chan
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada;
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC V5Z 1L3, Canada;
| | - Stuart J. Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC V5Z 1L3, Canada;
- British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada;
- Division of Biostatistics, University of Toronto, Toronto, ON M5S 1A1, Canada
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19
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Mofina A, Miller J, Tranmer J, Donnelly C. Home care rehabilitation therapy services for individuals with multimorbidity: A rapid review. JOURNAL OF COMORBIDITY 2020; 10:2235042X20976282. [PMID: 33312962 PMCID: PMC7716071 DOI: 10.1177/2235042x20976282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/02/2020] [Indexed: 11/24/2022]
Abstract
Multimorbidity refers to the co-occurrence of two or more chronic conditions, where no one disease is considered the central disease. Individuals with multimorbidity experience increased patient health complexity, increased disability and functional decline, and increased health care utilization. Rehabilitation therapists are well positioned to address the complex functional needs that can contribute to disability for people living with multimorbidity; however, it is not well understood how they address these needs within the home care setting. A rapid review was conducted to identify and synthesize the existing literature on home care rehabilitation services for clients with multimorbidity and the effect of those services. Two electronic databases (Medline and CINAHL) were searched. The Journal of Comorbidity was hand-searched for thoroughness because this journal focuses on populations with multiple chronic conditions. This rapid review included observational and experimental studies that focused on rehabilitation therapy interventions embedded within existing home care systems for adults with multimorbidity. Four studies were included in the final review. The results revealed that therapists delivered interventions aimed towards improving functional outcomes related to activities of daily living and instrumental activities of daily living. Physical therapy interventions were the only therapy delivered in three of the four studies included. Furthermore, 50% of these studies explicitly included people with chronic conditions impacting the musculoskeletal system only. This review offers an important perspective on how home care rehabilitation therapy interventions and outcomes are operationalized for individuals with multimorbidity. Despite the varying definitions of multimorbidity, therapeutic intervention supported functional improvements.
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Affiliation(s)
- Amanda Mofina
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, Kingston, Ontario, Canada.,Institute for Clinical and Evaluative Sciences (ICES) Queen's, Kingston, Ontario, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Krasovsky T, Lubetzky AV, Archambault PS, Wright WG. Will virtual rehabilitation replace clinicians: a contemporary debate about technological versus human obsolescence. J Neuroeng Rehabil 2020; 17:163. [PMID: 33298128 PMCID: PMC7724440 DOI: 10.1186/s12984-020-00769-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022] Open
Abstract
This article is inspired by a pseudo Oxford-style debate, which was held in Tel Aviv University, Israel at the International Conference on Virtual Rehabilitation (ICVR) 2019, which is the official conference of the International Society for Virtual Rehabilitation. The debate, between two 2-person teams with a moderator, was organized by the ICVR Program committee to address the question "Will virtual rehabilitation replace clinicians?" It brought together five academics with technical, research, and/or clinical backgrounds-Gerry Fluet, Tal Krasovsky, Anat Lubetzky, Philippe Archambault, W. Geoffrey Wright-to debate the pros and cons of using virtual reality (VR) and related technologies to help assess, diagnose, treat, and track recovery, and more specifically investigate the likelihood that advanced technology will ultimately replace human clinicians. Both teams were assigned a side to defend, whether it represented their own viewpoint or not, and to take whatever positions necessary to make a persuasive argument and win the debate. In this paper we present a recapitulation of the arguments presented by both sides, and further include an in-depth consideration of the question. We attempt to judiciously lay out a number of arguments that fall along a spectrum from moderate to extreme; the most extreme and/or indefensible positions are presented for rhetorical and demonstrative purposes. Although there may not be a clear answer today, this paper raises questions which are related to the basic nature of the rehabilitation profession, and to the current and potential role of technology within it.
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Affiliation(s)
- Tal Krasovsky
- Department of Physical Therapy, University of Haifa, Haifa, Israel
- Pediatric Rehabilitation Department, Sheba Medical Center, Ramat Gan, Israel
| | - Anat V Lubetzky
- Department of Physical Therapy, Steinhardt School of Culture Education and Human Development, New York University, New York, NY, USA
| | - Philippe S Archambault
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada
- CRIR - Centre de Recherche Interdisciplinaire en réadaptation, Montreal, Canada
| | - W Geoffrey Wright
- Neuromotor Sciences Program, Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, USA.
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21
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Seow H, Stevens T, Barbera LC, Burge F, McGrail K, Chan KKW, Peacock SJ, Sutradhar R, Guthrie DM. Trajectory of psychosocial symptoms among home care patients with cancer at end-of-life. Psychooncology 2020; 30:103-110. [PMID: 33007119 DOI: 10.1002/pon.5559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/11/2020] [Accepted: 09/21/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE Understanding the end-of-life psychosocial needs of cancer patients at home is a knowledge gap. This study describes the trajectory of psychosocial symptoms in the last 6 months of life among cancer decedents who were receiving home care. METHODS Observational population-based cohort study of cancer decedents who were receiving home care services between 2007 and 2014. Decedents had to have at least one home care assessment in the last 6 months of life for inclusion. Outcomes were the presence of psychosocial symptoms (i.e., anxiety, loneliness, depression, social decline, caregiver distress, and cognitive decline) at each week before death. RESULTS Our cohort included 27,295 unique cancer decedents (30,368 assessments), of which 58% died in hospital. Fifty-six percent were older than 74, and 47% were female. The prevalence of all symptoms increased approaching death, except loneliness. Social decline (48%-78%) was the most prevalent psychosocial symptom, though loneliness was reported in less than 10% of the cohort. Caregiver distress rose over time from 15%-27%. A third of the cohort reported issues with cognitive impairment. Multivariate regression showed that physical symptoms such as uncontrolled pain, impairment in independent activities of daily living, and a high level of health instability all significantly worsened the odds of having a psychosocial symptom in the last 3 months of life. CONCLUSION In this large home care cancer cohort, trajectories of psychosocial symptoms worsened close to death. Physical symptoms, such as uncontrolled pain, were associated with having worse psychosocial symptoms at end of life.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tara Stevens
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lisa C Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelvin K W Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada.,British Columbia Cancer Agency, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Biostatistics, University of Toronto, Toronto, Ontario, Canada
| | - Dawn M Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada.,Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
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Tsuchiya-Ito R, Ishizaki T, Mitsutake S, Hamada S, Yoshie S, Iijima K, Tamiya N. Association of household income with home-based rehabilitation and home help service utilization among long-term home care service users. BMC Geriatr 2020; 20:314. [PMID: 32859158 PMCID: PMC7456048 DOI: 10.1186/s12877-020-01704-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine the association of household income with home-based rehabilitation and home help services in terms of service utilization and expenditures. METHODS A secondary data analysis of cross-sectional design was conducted using long-term care (LTC) insurance claims data, medical claims data, and three types of administrative data. The subjects comprised LTC insurance beneficiaries in Kashiwa city, Japan, who used long-term home care services in the month following care needs certification. Household income was the independent variable of interest, and beneficiaries were categorized into low-income or middle/high-income groups based on their insurance premiums. Using a two-part model, the odds ratios (ORs) and 95% confidence intervals (CIs) for the utilization of home-based rehabilitation and home help services in the month following care needs certification were estimated using logistic regression analysis, and the risk ratios (RRs) of service expenditures were estimated using a generalized linear model for gamma-distributed data with a log-link function. RESULTS Among 3770 subjects, 681 (18.1%) used home-based rehabilitation and 1163 (30.8%) used home help services. There were 1419 (37.6%) low-income subjects, who were significantly less likely to use (OR: 0.813; 95%CI: 0.670-0.987) and spend on (RR: 0.910; 95%CI: 0.829-0.999) home-based rehabilitation services than middle/high-income subjects. Conversely, low-income subjects were significantly more likely to use (OR: 1.432; 95%CI: 1.232-1.664) but less likely to spend on (RR: 0.888; 95%CI: 0.799-0.986) home help services than middle/high-income subjects. CONCLUSION Household income was associated with the utilization of long-term home care services. To improve access to these services, the LTC insurance system should examine ways to decrease the financial burden of low-income beneficiaries and encourage service utilization.
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Affiliation(s)
- Rumiko Tsuchiya-Ito
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan. .,Dia Foundation for Research on Ageing Societies, Tokyo, Japan.
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Seigo Mitsutake
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.,Health Services Research & Development Center, University of Tsukuba, Ibaraki, Japan
| | - Satoru Yoshie
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.,Health Services Research & Development Center, University of Tsukuba, Ibaraki, Japan.,Institute of Gerontology, University of Tokyo, Tokyo, Japan.,Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.,Institute for Future Initiatives, The University of Tokyo, Ibaraki, Japan
| | - Katsuya Iijima
- Institute of Gerontology, University of Tokyo, Tokyo, Japan.,Institute for Future Initiatives, The University of Tokyo, Ibaraki, Japan
| | - Nanako Tamiya
- Health Services Research & Development Center, University of Tsukuba, Ibaraki, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Hassett L, van den Berg M, Weber H, Chagpar S, Wong S, Rabie A, McCluskey A, Lindley RI, Crotty M, Sherrington C. Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial - description of device use and physiotherapy support in the post-hospital phase. Disabil Rehabil 2020; 43:3454-3460. [PMID: 32663066 DOI: 10.1080/09638288.2020.1790679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To describe device use and physiotherapy support in the post-hospital phase of the AMOUNT rehabilitation trial. METHODS We performed an evaluation of the support required for device use by participants randomised to the intervention group who received digitally-enabled rehabilitation in the post-hospital phase (n = 144). Intervention, additional to standard rehabilitation, utilised eight digital devices (virtual reality videogames, activity monitors and handheld computer devices) to improve mobility and increase physical activity. Participants were taught to use devices during inpatient rehabilitation and were then discharged home to use the devices for the remainder of the 6-month trial. Physiotherapist-participant contact occurred every 1-2 weeks using a health coaching approach, including technology support when required. Intervention datasheets were audited, and descriptive statistics used to report device use and support required. RESULTS Participants (mean (SD) age 70 (18) years; 49% neurological health conditions) used an average of 2 (SD 1) devices (98% used an activity monitor). Eight percent of physiotherapy contact included technology support with 30% provided remotely. Support addressed 845 issues categorised under initial set-up and instruction (27%), education and training (31%), maintenance (23%) and trouble-shooting (19%). CONCLUSION Digital devices can be used for home-based rehabilitation, but ongoing technology support is essential. Clinical Trials Registry: ACTRN12614000936628IMPLICATIONS FOR REHABILITATIONDigital device use at home to support long-term management of health conditions is likely to become increasingly important as the need for rehabilitation increases and rehabilitation resources become more limited.Technology support for set-up and ongoing device use is a critical enabler of home-based digital interventions.Health professionals delivering home-based digital interventions require sufficient training and equipment and may need to vary the mode (e.g., home visit vs. telephone or video conference) depending on the technology support required.
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Affiliation(s)
- Leanne Hassett
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, Australia.,Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Maayken van den Berg
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Heather Weber
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sakina Chagpar
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - Siobhan Wong
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Ashley Rabie
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.,StrokeEd Collaboration, Sydney, Australia
| | - Richard I Lindley
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, Australia
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Frailty Index Status of Canadian Home Care Clients Improves With Exercise Therapy and Declines in the Presence of Polypharmacy. J Am Med Dir Assoc 2020; 21:766-771.e1. [DOI: 10.1016/j.jamda.2020.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 11/30/2022]
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Hirdes JP, Heckman GA, Morinville A, Costa A, Jantzi M, Chen J, Hébert PC. One Way Out? A Multistate Transition Model of Outcomes After Nursing Home Admission. J Am Med Dir Assoc 2019; 20:1425-1431.e1. [DOI: 10.1016/j.jamda.2019.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
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Lindmark U, Bülow PH, Mårtensson J, Rönning H. The use of the concept of transition in different disciplines within health and social welfare: An integrative literature review. Nurs Open 2019; 6:664-675. [PMID: 31367388 PMCID: PMC6650790 DOI: 10.1002/nop2.249] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 12/03/2018] [Accepted: 01/15/2019] [Indexed: 11/20/2022] Open
Abstract
AIMS To continuing the quest of the concept of transition in nursing research and to explore how the concept of transition is used in occupational therapy, oral health and social work as well as in interdisciplinary studies in health and welfare, between 2003-2013. DESIGN An integrative literature review. METHODS PubMed, CINAHL, PsycINFO, DOSS, SocIndex, Social Science Citation Index and AMED databases from 2003-2013 were used. Identification of 350 articles including the concept of transition in relation to disciplines included. Assessment of articles are in accordance to Meleis' typologies of transition by experts in each discipline. Chosen key factors were entered into Statistical Package for the Social Sciences (SPSS). RESULTS Meleis' four typologies were found in all studied disciplines, except development in oral health. The health-illness type was the most commonly explored, whereas in social work and in occupation therapy, situational transitions dominated.
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Affiliation(s)
- Ulrika Lindmark
- Department of Natural Science and Bio Medicine, Center for Oral Health, School of Health and WelfareJönköping UniversityJönköpingSweden
| | - Pia H. Bülow
- Department of Social Work, School of Health and WelfareJönköping UniversityJönköpingSweden
- Department of Social WorkUniversity of the Free StateBloemfonteinSouth Africa
| | - Jan Mårtensson
- Department of Nursing, School of Health and WelfareJönköping UniversityJönköpingSweden
| | - Helén Rönning
- School of Health and WelfareJönköping UniversityJönköpingSweden
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27
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Hébert PC, Morinville A, Costa A, Heckman G, Hirdes J. Regional variations of care in home care and long-term care: a retrospective cohort study. CMAJ Open 2019; 7:E341-E350. [PMID: 31110112 PMCID: PMC6527434 DOI: 10.9778/cmajo.20180086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many aging adults undergo progressive loss of autonomy, develop increasingly complex medical needs and experience multiple care transitions. We sought to determine the degree of variation in rates of transfer from home care services and long-term care in several Canadian jurisdictions. METHODS In this retrospective cohort study, we examined transitions from home care services and long-term care to different possible end states: change in health stability (getting better or worse), transfer to hospital, transfer to another care setting or death. We used standardized interRAI assessments from long-term care and home care linked to hospital records (data from the Discharge Abstract Database and National Ambulatory Care Reporting System) from 2010 to 2016. Multistate modelling was used to adjust for patients with complex health status and transitions in care. RESULTS We report data for 254 664 patients in home care programs and 162 045 residents in long-term care. Compared with patients in Ontario, patients requiring home care services in Alberta and British Columbia had increased odds of being admitted to hospital regardless of the underlying severity of illness (the adjusted odds ratios [OR] ranged from 2.08 to 3.77 in Alberta and from 1.28 to 1.46 in BC). Residents in long-term care in Alberta and BC had less than half the odds of being transferred to hospital, independent of all other factors, when compared with long-term care residents in Ontario (the adjusted OR ranged from 0.38 to 0.39 in Alberta and from 0.33 to 0.44 in BC). INTERPRETATION Significant variations in transfer rates were observed between provinces, even after controlling for individual patient characteristics. These results suggest that transfers to hospital are largely driven by health care policies, health care professional practice patterns and available infrastructure rather than individual patient needs.
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Affiliation(s)
- Paul C Hébert
- Département de médecine (Hébert), Université de Montréal and Centre hospitalier de l'Université de Montréal, Montréal, Que.; Novartis Pharmaceuticals Canada Inc. (Morinville), Dorval, Que.; Centre de recherche du Centre hospitalier de l'Université de Montréal (Hébert) (Morinville, during the conduct of the study), Montréal, Que.; Departments of Medicine, and Health Research Methods, Evidence, and Impact (Costa), McMaster University, Hamilton, Ont.; Research Institute for Aging, School of Public Health and Health Systems (Heckman); School of Public Health and Health Systems (Hirdes), University of Waterloo, Waterloo, Ont.
| | - Anne Morinville
- Département de médecine (Hébert), Université de Montréal and Centre hospitalier de l'Université de Montréal, Montréal, Que.; Novartis Pharmaceuticals Canada Inc. (Morinville), Dorval, Que.; Centre de recherche du Centre hospitalier de l'Université de Montréal (Hébert) (Morinville, during the conduct of the study), Montréal, Que.; Departments of Medicine, and Health Research Methods, Evidence, and Impact (Costa), McMaster University, Hamilton, Ont.; Research Institute for Aging, School of Public Health and Health Systems (Heckman); School of Public Health and Health Systems (Hirdes), University of Waterloo, Waterloo, Ont
| | - Andrew Costa
- Département de médecine (Hébert), Université de Montréal and Centre hospitalier de l'Université de Montréal, Montréal, Que.; Novartis Pharmaceuticals Canada Inc. (Morinville), Dorval, Que.; Centre de recherche du Centre hospitalier de l'Université de Montréal (Hébert) (Morinville, during the conduct of the study), Montréal, Que.; Departments of Medicine, and Health Research Methods, Evidence, and Impact (Costa), McMaster University, Hamilton, Ont.; Research Institute for Aging, School of Public Health and Health Systems (Heckman); School of Public Health and Health Systems (Hirdes), University of Waterloo, Waterloo, Ont
| | - George Heckman
- Département de médecine (Hébert), Université de Montréal and Centre hospitalier de l'Université de Montréal, Montréal, Que.; Novartis Pharmaceuticals Canada Inc. (Morinville), Dorval, Que.; Centre de recherche du Centre hospitalier de l'Université de Montréal (Hébert) (Morinville, during the conduct of the study), Montréal, Que.; Departments of Medicine, and Health Research Methods, Evidence, and Impact (Costa), McMaster University, Hamilton, Ont.; Research Institute for Aging, School of Public Health and Health Systems (Heckman); School of Public Health and Health Systems (Hirdes), University of Waterloo, Waterloo, Ont
| | - John Hirdes
- Département de médecine (Hébert), Université de Montréal and Centre hospitalier de l'Université de Montréal, Montréal, Que.; Novartis Pharmaceuticals Canada Inc. (Morinville), Dorval, Que.; Centre de recherche du Centre hospitalier de l'Université de Montréal (Hébert) (Morinville, during the conduct of the study), Montréal, Que.; Departments of Medicine, and Health Research Methods, Evidence, and Impact (Costa), McMaster University, Hamilton, Ont.; Research Institute for Aging, School of Public Health and Health Systems (Heckman); School of Public Health and Health Systems (Hirdes), University of Waterloo, Waterloo, Ont
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28
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Functional Recovery Within a Formal Home Care Program. J Am Med Dir Assoc 2019; 20:1001-1006. [PMID: 30738824 DOI: 10.1016/j.jamda.2018.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify home care clients with substantial functional deficits who had capacity to improve and, thus, for whom recovery goals should be articulated. DESIGN Retrospective longitudinal analysis of an international home care database. SETTING AND PARTICIPANTS 523,907 persons receiving home care, having 2 assessments, on average, 8 months apart. MEASURES Recovery algorithm variables included counts of dependencies of activities of daily living (ADL) and instrumental ADL (IADL) tasks, hospitalization in the last 30 days, functional decline in the last 90 days, and self-belief in one's capacity to improve. Primary dependent variable was improvement in the IADL-ADL Functional Hierarchy Scale. RESULTS The Recovery Algorithm has 7 graded levels: the top 3 represent approximately 9% of home care clients, whereas the bottom level (where recovery is least likely to occur) includes 60% of home care clients (many with higher counts of extensive ADL or IADL dependencies). The improvement rates rise from 6.9% to 47.2% across the 7 levels of the algorithm. This relationship between change in IADL-ADL Functional Hierarchy Scale scores and Recovery Algorithm levels remained strong across age categories and cognitive performance levels. Higher rates of improvement occurred for persons who received physical therapy. CONCLUSIONS/IMPLICATIONS The Recovery Algorithm is based on a mix of positive risk indicators and the person's challenged baseline functional status. For persons with higher scores on the algorithm, recovery is expected and should be considered in care plan goals. In addition, use of physical therapy increases the probability of recovery.
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Potential quality indicators for seriously ill home care clients: a cross-sectional analysis using Resident Assessment Instrument for Home Care (RAI-HC) data for Ontario. BMC Palliat Care 2019; 18:3. [PMID: 30626374 PMCID: PMC6325754 DOI: 10.1186/s12904-018-0389-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Currently, there are no formalized measures for the quality of home based palliative care in Ontario. This study developed a set of potential quality indicators for seriously ill home care clients using a standardized assessment. Methods Secondary analysis of Resident Assessment Instrument for Home Care data for Ontario completed between 2006 and 2013 was used to develop quality indicators (QIs) thought to be relevant to the needs of older (65+) seriously ill clients. QIs were developed through a review of the literature and consultation with subject matter experts in palliative care. Serious illness was defined as a prognosis of less than 6 months to live or the presence of severe health instability. The rates of the QIs were stratified across Ontario’s geographic regions, and across four common life-limiting illnesses to observe variation. Results Within the sample, 14,312 clients were considered to be seriously ill and were more likely to experience negative health outcomes such as cognitive performance (OR = 2.77; 95% CI: 2.66–2.89) and pain (OR = 1.59; 95% CI: 1.53–1.64). Twenty subject matter experts were consulted and a list of seven QIs was developed. Indicators with the highest overall rates were prevalence of falls (50%) prevalence of daily pain (47%), and prevalence of caregiver distress (42%). The range in QI rates was largest across regions for prevalence of caregiver distress (21.5%), the prevalence of falls (16.6%), and the prevalence of social isolation (13.7%). Those with some form of dementia were most likely to have a caregiver that was distressed (52.6%) or to experience a fall (53.3%). Conclusion Home care clients in Ontario who are seriously ill are experiencing high rates of negative health outcomes, many of which are amenable to change. The RAI-HC can be a useful tool in identifying these clients in order to better understand their needs and abilities. These results contribute significantly to the process of creating and validating a standardized set of QIs that can be generated by organizations using the RAI-HC as part of normal clinical practice.
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Heckman GA, Hirdes JP, Hébert PC, Morinville A, Amaral ACKB, Costa A, McKelvie RS. Predicting Future Health Transitions Among Newly Admitted Nursing Home Residents With Heart Failure. J Am Med Dir Assoc 2018; 20:438-443. [PMID: 30573437 DOI: 10.1016/j.jamda.2018.10.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/25/2018] [Accepted: 10/30/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To understand how a heart failure diagnosis and admission health instability predict health transitions and outcomes among newly admitted nursing home residents. DESIGN Retrospective cohort study of linked administrative data, including the Continuing Care Report System MDS 2.0 for nursing homes, the Discharge Abstract Database for hospitalized patients, and National Ambulatory Care Reporting System to track emergency department visits. SETTING AND PARTICIPANTS Older adults, aged 65 years and above, admitted to nursing homes in Ontario, Alberta, and British Columbia, Canada, from 2010 to 2016. MEASURES Mortality and hospitalization were plotted over 1 year. Multistate Markov models were used to estimate adjusted odds ratios (ORs) for transitions to different states of health in stability, hospitalization, and death, stratified by heart failure diagnosis and by interRAI Changes in Health and End-stage disease Signs and Symptoms (CHESS) score, at 90 days following admission to a nursing home. RESULTS The final sample included 143,067 residents. Adverse events were most common in the first 90 days. A diagnosis of heart failure predicted worsening health instability, hospitalizations, and mortality. The effect of heart failure on hospitalizations and death was strongest for low baseline health instability (CHESS = 0; OR 1.63, 95% confidence interval (CI) 1.58-1.68, and OR 1.71, 95% CI 1.57-1.86, respectively), versus moderate instability (CHESS = 1-2; OR 1.36, 95% CI 1.32-1.39, and OR 1.48, 95% CI 1.41-1.55), versus high instability (CHESS = 3; OR 1.12, 95% CI 1.03-1.23, and OR 1.21, 95% CI 1.11-1.32). The magnitude of the impact of a heart failure diagnosis was greatest for lower baseline health instability. Residents with the highest degree of health instability were also most likely to die in hospital. CONCLUSIONS AND IMPLICATIONS A diagnosis of heart failure and health instability provide complementary information to predict transfers, deaths, and adverse outcomes. Clearly identifying these at-risk patients may be useful in targeting interventions in nursing homes.
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Affiliation(s)
- George A Heckman
- Research Institute for Ageing, Waterloo, Ontario, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
| | - John P Hirdes
- Research Institute for Ageing, Waterloo, Ontario, Canada
| | - Paul C Hébert
- Département de Médecine, Université de Montréal et Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Anne Morinville
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Andre C K B Amaral
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrew Costa
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Abstract
RÉSUMÉLes prévisions liées au vieillissement de la population canadienne impliquent que la demande en soins à domicile augmentera significativement. À ce jour, peu d’études ont été menées au Canada sur les soins à domicile pour les personnes âgées, notamment sur les caractéristiques des bénéficiaires de soins à domicile, les lacunes dans les services, ou les interventions permettant de répondre aux besoins des clients en matière de soins à domicile. Une revue systématique de sept bases de données électroniques a été réalisée pour les années 2000-2016 afin d’examiner les connaissances actuelles dans le domaine des soins à domicile pour les personnes âgées au Canada. Cette synthèse était centrée sur quatre principaux thèmes retrouvés dans la littérature : les prédicteurs au niveau de la personne âgée, les besoins de soins non comblés, les interventions, les enjeux et les défis dans les soins à domicile. Cette revue a mis en évidence plusieurs lacunes dans les connaissances liées aux soins à domicile pour les personnes âgées au Canada, considérant que plus de la moitié des études étaient centrées sur le contexte ontarien. Bien que des stratégies prometteuses aient été mises en évidence, davantage de recherche et d’évaluation des interventions et des résultats sont requises pour appuyer efficacement le système de soins à domicile au Canada, à court et à long terme.
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Wright RL, Brownless SB, Pratt D, Sackley CM, Wing AM. Stepping to the Beat: Feasibility and Potential Efficacy of a Home-Based Auditory-Cued Step Training Program in Chronic Stroke. Front Neurol 2017; 8:412. [PMID: 28878730 PMCID: PMC5572237 DOI: 10.3389/fneur.2017.00412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/31/2017] [Indexed: 11/24/2022] Open
Abstract
Background Hemiparesis after stroke typically results in a reduced walking speed, an asymmetrical gait pattern and a reduced ability to make gait adjustments. The purpose of this pilot study was to investigate the feasibility and preliminary efficacy of home-based training involving auditory cueing of stepping in place. Methods Twelve community-dwelling participants with chronic hemiparesis completed two 3-week blocks of home-based stepping to music overlaid with an auditory metronome. Tempo of the metronome was increased 5% each week. One 3-week block used a regular metronome, whereas the other 3-week block had phase shift perturbations randomly inserted to cue stepping adjustments. Results All participants reported that they enjoyed training, with 75% completing all training blocks. No adverse events were reported. Walking speed, Timed Up and Go (TUG) time and Dynamic Gait Index (DGI) scores (median [inter-quartile range]) significantly improved between baseline (speed = 0.61 [0.32, 0.85] m⋅s−1; TUG = 20.0 [16.0, 39.9] s; DGI = 14.5 [11.3, 15.8]) and post stepping training (speed = 0.76 [0.39, 1.03] m⋅s−1; TUG = 16.3 [13.3, 35.1] s; DGI = 16.0 [14.0, 19.0]) and was maintained at follow-up (speed = 0.75 [0.41, 1.03] m⋅s−1; TUG = 16.5 [12.9, 34.1] s; DGI = 16.5 [13.5, 19.8]). Conclusion This pilot study suggests that auditory-cued stepping conducted at home was feasible and well-tolerated by participants post-stroke, with improvements in walking and functional mobility. No differences were detected between regular and phase-shift training with the metronome at each assessment point.
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Affiliation(s)
- Rachel L Wright
- School of Psychology, University of Birmingham, Birmingham, United Kingdom.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - David Pratt
- West Midlands Rehabilitation Centre, Birmingham Community Healthcare Trust, Birmingham, United Kingdom
| | - Catherine M Sackley
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Alan M Wing
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
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Vega-Ramírez FA, López-Liria R, Granados-Gámez G, Aguilar-Parra JM, Padilla-Góngora D. Analysis of home-based rehabilitation in patients with motor impairment in primary care: a prospective observational study. BMC Geriatr 2017; 17:145. [PMID: 28705187 PMCID: PMC5513088 DOI: 10.1186/s12877-017-0526-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 06/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of health and social policies is to encourage older people more longevity, remain free of disability and experience quality of life while living in their homes. The aim of this study was to describe the characteristics of 473 patients diagnosed with motor impairment in primary care, the objectives of home-based rehabilitation and its functional impact. Methods This prospective observational study was conducted in the Almería Health District. The analysed variables included age, gender, secondary diagnosis, Barthel Index (BI), physiotherapeutic objectives and techniques, and number of sessions. Results The sample had a mean age of 83 years, and 59% were women. The assessed conditions with a high prevalence included osteoarticular pathology (55%), Alzheimer’s disease (15.1%), cardiovascular disease (13.7%) and stroke (6.5%). The techniques applied mainly consisted of functional exercises (57.1%), caregiver education (13.8%), and technical assistance (5.7%). There were statistically significant differences (t = −15.79; p < 0.001) between initial (X = 34.8) and final BI (X = 48.1), with an improvement of 13.4 points in patients’ functional capacity (95% confidence interval [CI]: −15.0 to −11.7). An equation was constructed to predict patients’ final BI as a function of the initial BI using a multiple linear regression model. The regression model explained 78% of the variance in patients with motor impairment. Conclusions Important improvements were obtained in terms of functional capacity with a mean of ten sessions of physiotherapy. Lower patient age was correlated with higher initial and final functional capacities in primary care. This study aimed to present a useful starting point for decision making among management and health administration regarding this population group by approaching the process from the reality of practice and in relation to the rehabilitation provided. Trial registration ClinicalTrials.gov identifier: NCT02715245; Date of registration: 18 January 2016.
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Affiliation(s)
- Francisco Antonio Vega-Ramírez
- Complejo Hospitalario Torrecárdenas. Servicio Andaluz de Salud, Carretera del Sacramento s/n. La Cañada de San Urbano, 04250, Almería, Spain
| | - Remedios López-Liria
- Department of Nursing, Physiotherapy and Medicine, CERNEP. University of Almería, Carretera del Sacramento s/n. La Cañada de San Urbano, 04250, Almería, Spain.
| | - Genoveva Granados-Gámez
- Department of Nursing, Physiotherapy and Medicine University of Almería, Carretera del Sacramento s/n. La Cañada de San Urbano, 04250, Almería, Spain
| | - Jose Manuel Aguilar-Parra
- Department of Psychology, University of Almería, Carretera del Sacramento s/n. La Cañada de San Urbano, 04250, Almería, Spain
| | - David Padilla-Góngora
- Department of Psychology, University of Almería, Carretera del Sacramento s/n. La Cañada de San Urbano, 04250, Almería, Spain
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Chase JAD, Huang L, Russell D, Hanlon A, O'Connor M, Robinson KM, Bowles KH. Racial/ethnic disparities in disability outcomes among post-acute home care patients. J Aging Health 2017; 30:1406-1426. [PMID: 28662602 DOI: 10.1177/0898264317717851] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine activities of daily living (ADL) disability outcomes among racially/ethnically diverse elders receiving home care (HC) after hospitalization. METHOD We conducted a retrospective cohort analysis of single-agency, 2013-2014 Outcome and Assessment Information Set data from older adults who received post-hospitalization HC ( n = 20,674). We measured overall change in ADL disability by summing the difference of standardized admission and discharge scores from nine individual ADL. Associations between race/ethnicity and overall ADL change scores were modeled using general linear regression, adjusting for covariates consistent with the Disablement Model. RESULTS Overall, patients experienced improvement in ADL disability from HC admission to discharge. However, Asian, African American, and Hispanic patients experienced significantly less improvement compared with non-Hispanic Whites (all p < .001), even after controlling for covariates. DISCUSSION Racial/ethnic disparities exist in ADL disability improvement among HC patients. Research is needed to clarify mechanisms underlying these disparities. Disablement Model factors may be targets for clinical intervention.
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Affiliation(s)
- Jo-Ana D Chase
- 1 University of Pennsylvania, Philadelphia, USA.,2 University of Missouri, Columbia, USA
| | | | - David Russell
- 3 Visiting Nurse Service of New York, New York City, USA
| | | | | | - Keith M Robinson
- 1 University of Pennsylvania, Philadelphia, USA.,5 Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Kathryn H Bowles
- 1 University of Pennsylvania, Philadelphia, USA.,3 Visiting Nurse Service of New York, New York City, USA
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Zingmark M, Nilsson I, Norström F, Sahlén KG, Lindholm L. Cost effectiveness of an intervention focused on reducing bathing disability. Eur J Ageing 2016; 14:233-241. [PMID: 28936134 PMCID: PMC5587451 DOI: 10.1007/s10433-016-0404-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The onset of bathing disability among older people is critical for a decline in functioning and has implications for both the individuals’ quality of life and societal costs. The aim of this study was to evaluate long-term cost effectiveness of an intervention targeting bathing disability among older people. For hypothetical cohorts of community-dwelling older people with bathing disability, transitions between states of dependency and death were modelled over 8 years including societal costs. A five-state Markov model based on states of dependency was used to evaluate Quality-adjusted life years (QALYs) and costs from a societal perspective. An intervention group was compared with a no intervention control group. The intervention focused on promoting safe and independent performance of bathing-related tasks. The intervention effect, based on previously published trials, was applied in the model as a 1.4 increased probability of recovery during the first year. Over the full follow-up period, the intervention resulted in QALY gains and reduced societal cost. After 8 years, the intervention resulted in 0.052 QALYs gained and reduced societal costs by €2410 per person. In comparison to the intervention cost, the intervention effect was a more important factor for the magnitude of QALY gains and long-term societal costs. The intervention cost had only minor impact on societal costs. The conclusion was that an intervention targeting bathing disability among older people presents a cost-effective use of resources and leads to both QALY gains and reduced societal costs over 8 years.
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Affiliation(s)
- Magnus Zingmark
- Division of Occupational Therapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.,Graduate School in Population Dynamics and Public Policy, Umeå University, Umeå, Sweden.,Community Care Administration, Municipality of Östersund, 83182 Östersund, Sweden
| | - Ingeborg Nilsson
- Division of Occupational Therapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.,ALC (Ageing and Living Conditions), Umeå University, Umeå, Sweden
| | - Fredrik Norström
- Epidemiology and Public Health, Umeå University, 90187 Umeå, Sweden
| | - Klas Göran Sahlén
- Epidemiology and Public Health, Umeå University, 90187 Umeå, Sweden.,Department of Nursing, Umeå University, Umeå, Sweden
| | - Lars Lindholm
- Epidemiology and Public Health, Umeå University, 90187 Umeå, Sweden
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Armstrong JJ, Sims-Gould J, Stolee P. Allocation of Rehabilitation Services for Older Adults in the Ontario Home Care System. Physiother Can 2016; 68:346-354. [PMID: 27904234 DOI: 10.3138/ptc.2014-66] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Physiotherapy and occupational therapy services can play a critical role in maintaining or improving the physical functioning, quality of life, and overall independence of older home care clients. Despite their importance, however, there is limited understanding of the factors that influence how rehabilitation services are allocated to older home care clients. The aim of this pilot study was to develop a preliminary understanding of the factors that influence decisions to allocate rehabilitation therapy services to older clients in the Ontario home care system, as perceived by three stakeholder groups. Methods: Semi-structured interviews were conducted with 10 key informants from three stakeholder groups: case managers, service providers, and health system policymakers. Results: Drivers of the allocation of occupational therapy and physiotherapy for older adults included functional needs and postoperative care. Participants identified challenges in providing home care rehabilitation to older adults, including impaired cognition and limited capacity in the home care system. Conclusions: Considering the changing demands for home care services, knowledge of current practices across the home care system can inform efforts to optimize rehabilitation services for the growing number of older adults. Further research is needed to advance the understanding of, and optimize rehabilitation service allocation to, older frail clients with multiple morbidities. Developing novel decision-support mechanisms and standardized clinical care pathways for older client populations may be beneficial.
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Affiliation(s)
- Joshua J Armstrong
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University, Halifax, N.S
| | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ont
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Gomes IM, Lacerda MR, Mercês NNAD. [The network social support experience of people involved in home care]. Rev Esc Enferm USP 2014; 48:484-91. [PMID: 25076277 DOI: 10.1590/s0080-623420140000300014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/30/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To build a theoretical model to configure the network social support experience of people involved in home care. METHOD A quantitative approach research, utilizing the Grounded Theory method. The simultaneous data collection and analysis allowed the interpretation of the phenomenon meaning The network social support of people involved in home care. RESULTS The population passive posture in building their well-being was highlighted. The need of a shared responsibility between the involved parts, population and State is recognized. CONCLUSION It is suggested for nurses to be stimulated to amplify home care to attend the demands of caregivers; and to elaborate new studies with different populations, to validate or complement the proposed theoretical model.
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Armstrong JJ, Zhu M, Hirdes JP, Stolee P. Rehabilitation therapies for older clients of the Ontario home care system: regional variation and client-level predictors of service provision. Disabil Rehabil 2014; 37:625-31. [PMID: 24981016 DOI: 10.3109/09638288.2014.935494] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine regional variation in service provision and identify the client characteristics associated with occupational therapy (OT) and physiotherapy (PT) services for older adults in the Ontario Home Care System. METHODS Secondary analyses of a provincial database containing comprehensive assessments (RAI-HC) linked with service utilization data from every older long-stay home care client in the system between 2005 and 2010 (n = 299 262). Hierarchical logistic regression models were used to model the dependent variables of OT and PT service use within 90 d of the initial assessment. RESULTS Regional differences accounted for 9% of the variation in PT service provision and 20% of OT service provision. After controlling for the differences across regions, the most powerful predictors of service provision were identified for both OT and PT. The most highly associated client characteristics related to PT service provision were hip fracture, impairments in activities of daily living/instrumental activities of daily living, cerebrovascular accidents, and cognitive impairment. For OT, hazards in the home environment was the most powerful predictor of future service provision. CONCLUSIONS Where a client lived was an important determinant of service provision in Ontario, raising the possibility of inequities in access to rehabilitation services. Health care planners and policy makers should review current practices and make adjustments to meet the increasing and changing needs for rehabilitation therapies of the aging population. Implications for Rehabilitation For older adults in home care, the goal of rehabilitation therapy services is to allow individuals to maintain or improve physical functioning, quality of life and overall independence while living within their community. Previous research has demonstrated that a large proportion of home care clients specifically identified as having rehabilitation potential do not receive it. This article used clinical assessment data to identify the predictors of and barriers to rehabilitation services for older adults in the Ontario Home Care System. Barriers of PT included dementia diagnosis and French as a first language. Barriers to OT included dementia diagnosis. Policies and practices related to service provision for older adults should be reconsidered if we are going to meet the demands of aging populations and increasing rates of functional and cognitive impairments.
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Affiliation(s)
- Joshua J Armstrong
- Geriatric Medicine Research, Dalhousie University , Halifax, Nova Scotia , Canada
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